PRESENTATION FOR Bsc. honors nursing students

1. NEONATAL
JAUNDICE
CLASS PRESENTATIONON
PRESENTED TO : MRS.RAJITHA MA’AM
TUTOR
PRESENTED BY : SHRUTI SHARMA
BSC HONORS NURSING 3rdYEAR
PRESENTED ON : 14 DECEMBER 2020

2. INTRODUCTION
Jaundice is the visible manifestation of
hyperbilirubinemia .The clinical jaundice
in neonates appear on the face at a
serum bilirubin level more than 5 mg/dl,
whereas in adults ,it is diagnosed as little
as 2mg/dl.The yellowish discolouration is
first seen on the skin of face ,nasolabial
folds and tip of nose in the neonates .

3. It is detected by blanching the skin with
digital pressure in the natural light.
Neonatal jaundice is termed as icterus
neonatorum or as neonates
hyperbilirubinemia .Almost 60 percent of
term neonates and about 80 percent
preterm neonates have bilirubin >5mg/dl
in the first week of life and 6 percent of
term babies will have bilirubin levels
exceeding 15mg/dl.

4. DEFINITION
Neonatal jaundice is a
yellowing of a baby’s skin
and eyes .Neonatal
jaundice is very common
and can occur when babies
have a high level of
bilirubin ,a yellow pigment
produced during normal
breakdown of red blood
cells.

5.  Physiological jaundice
 Pathological jaundice
 Breast milk jaundice
 Breast feeding jaundice
TYPES OF NEONATAL
JAUNDICE

6. Physiological jaundice

7.  It appears in between 30 to 72 hours of age in
term babies and in preterm babies may
appear earlier but not before 24 hours of age
 Maximum intensity of jaundice is found on the
4th day in term babies and 5th to 6th day in
preterm babies .
 Serum bilirubin does not exceed 15mg/dl.
 Usually disappears by 7th to 10th day in term
babies and by 14th day in preterm babies.
 Subsides spontaneously and no treatment is
needed.

8.  Mother needs arrangement
for exclusive breastfeeding
for adequate hydration
and reassurance.
 Careful observation for
signs of complications along
with essential neonatal
care are important.
 May aggravated by
prematurity, asphyxia,
hypothermia ,infections
and drugs.

9. PATHOLOGICAL JAUNDICE

10. Clinical jaundice appears within 24 hours of
birth and persist more than one week in
term babies and babies more than 2 weeks
in preterm babies .
 Bilirubin level is increasing by more than
5mg/dl per day or 0.5mg/dl per hour.
 Total bilirubin level is more than
15mg/dl(hyperbilirubinemia).
 Palms and soles are yellow.
 Stool clay or white colored and urine is
staining clothes.

11. BREAST milk jaundice

12. Although breast milk jaundice is quite rare ,it
often causes concern in part because why it
happen is unclear .There may be differences in
the infant’s reabsorption of the bilirubin, or in the
mother’s milk. Breast milk jaundice can appear
2-5 days after birth. Bilirubin levels peak around
10-14 days but they may remain high for several
weeks ,even as much as 3 months. If the bilirubin
level continues to climb ,the baby’s health care
provider may suggesting donor breast milk or
formulae until jaundices resolves.in rare cases
,breastfeeding may be interrupted for 24 hours, in
an effort to reduce the bilirubin level.

13. BREAST FEEDING
JAUNDICE

14. Also called as “lack of breastfeeding
jaundice or starvation jaundice” this is
caused by frequent or ineffective
breastfeeding. It is result of too little
breastfeeding and therefore low caloric
bilirubin metabolism and transport. All of
this cause bilirubin levels to be higher in
the infant’s blood .Formula milk is no “cure
all” for this kind of jaundice ;the key is to
make sure your child is taking enough
calories.

16. PHYSIOLOGICAL
JAUNDICE

17.  Increased bilirubin load on hepatic cells
 Defective bilirubin conjugation
 Defective uptake of bilirubin
 Defective bilirubin excretion
Multiple factors are responsible for the
physiological jaundice which commonly
found in both term and preterm babies.This
is elevation of unconjugated bilirubin
concentration due to various reasons in the
first week of life. The possible etiology for
physiological jaundice are as follows:-

18. PATHOLOGICAL
JAUNDICE

19. Pathological jaundice also caused by :- About
5 percent of neonates develop pathological
jaundice. Appearance of jaundice within 24
hours of age is always pathological. Some
causes of this condition may appear after 72
hours, though age of appearance of jaundice
may overlap. Investigation should be done to
ruled out the exact cause of pathological
jaundice .

20. I. In severe hemolysis
II.Excessive destruction of RBCs due to
hemolytic diseases of newborn
III.Defective conjugation of bilirubin

21. IV. Failure to excrete the conjugated bilirubin
V. Miscellaneous: viral hepatitis, malaria,
intrauterine infections hypothyroidism, alpha
thalaseemia ,drug therapy (vitamin K,
salicylates)

22. Rh-immunization is also
called as
erythroblastosis fetalis ,
a major cause of severe
hyperbilirubinemia.
Rh- incompatibility

23. It occurs commonly in ‘O’ group mother and ‘A’ or ‘B’ group
fetus . it is milder than Rh – hemolytic disease and may occur
even in first born baby. The disease can be diagnosed by
examining cord blood for elevation of serum bilirubin and
presence of maternal IgG anti ‘A’ or anti ‘B’ antibodies .
Direct coomb ‘s test generally negative or weekly positive .
ABO- incompatibility

24. MINOR GROUP
INCOMPATIBILITY
: Immunization can
occur for minor
groups
incompatibility like
kidd, Duffy etc
OTHER CAUSES :
Insufficiency in
infant reabsorption
of bilirubin
Infrequent or
ineffective
breastfeeding

30. Unconjugated bilirubin may penetrate brain
cells by crossing blood brain in some
circumstances and results in neurological
dysfunction and death. Bilirubin level should be
monitored to present the following
complications in neonates:-

32. Transient encephalopathy:- It is reversible
neurologic complication suspected in
increasing lethargy along with rising
bilirubin levels. Recovery is possible with
prompt initiation of management and
exchange blood transfusion.

33. KERNICTERUS

34. Kernicterus:- it is a pathological condition
of brain due to toxicity by unconjugated
bilirubin. It occurs as a result of necrosis of
neurons in basal ganglia ,hippocampal
cortex, subthalamic nuclei and cerebellum
followed by gliosis of the areas. The
cerebral cortex usually is not affected.
Other lesions include necrosis of renal
tubular cells, intestinal mucosa and
pancreatic cells which may present as GI
bleeding or hematuria.

35. OTHER MENIFESTATIONS ARE:
 Poor sucking
 Lethargy
 Hypotonia
 Poor or absent Moro reflex
 Alteration of consciousness
 Fever
 High pitch cry
 Convulsions
 Twitching
 Nystagmus

46. *Management of neonatal jaundice is aimed
of reduction of serum bilirubin level within
safe limit and prevention of CNS toxicity as
kernicterus and brain damage .The
management include:
I. Prevention of Rh-isoimmunization by anti-D
gamma globulin to RH-negative mother in case
of birth of Rh- positive baby.
II. Reduction of bilirubin level by phototherapy and
exchange blood transfusion and prevention of
bilirubinemia.
III. Reduction of enterohepatic circulation by drug
therapy

48. PHOTOTHERAPY
*It is non invasive , inexpensive and easy
method of degradation of unconjugated
bilirubin by photo-oxidation. The light
waves converted the toxic bilirubin into
water soluble non –toxic from which is
easily excreted from the blood in the bile
, stool and urine .Phototherapy also
enhances hepatic excretion of
unconjugated bilirubin into the intestinal
lumen.

51. Double surface phototerapy
can be far more effective
management,when the
infant is placed on a optic
fibre cool biliblanket.
Maximum spectral
irradiance or flux is 4 to 6
UW/cm square/nm to be
maintained on infant skin
and should be checked
every 100-200hours.
It should be discontinued
when serum bilirubin is less
than 10mg/dl for 2 times .

52. DRUG THERAPY IN NEONATAL
JAUNDICE
The drugs have very little role in the treatment
of neonatal jaundice.They act by interfering
with heme-degradation , acceleration method
pathway of bilirubin clearance and by
inhibiting enterohepatic circulations.
The drug which can be used to bind
unconjugated bilirubin in the gut and prevent
its recirculation are charcoal , agar , polyvinyl
pyrrolidone and cholestyramine.

53. EXCHANGE BLOOD TRANSFUSION
EBT is most effective and reliable method for
reduction of bilirubin level in case of severe
hyperbilirubinemia to prevent kernicterus and to
correct anemia.
Combining phenobarbitone with phototherapy is
no more effective than phototherapy alone and
hence not used in routine clininals practices.

61. 1. Fluid volume deficit r / t
inadequate fluid intake,
phototherapy, and diarrhea.
INTERVENTIONS
Record the number and quality of
stool
Monitor skin turgor
Monitor intake output
Give breastfeeding or bottle-feed.

62. 2 . Increased body temperature
r / t effects of phototherapy .
INTERVENTIONS
Give a neutral ambient
temperature
Keep the temperature between
35.5 - 37 ° C
Check vital signs every 2 hours.

63. 3 . Impaired skin integrity r / t
hyperbilirubinemia and diarrhoea .
INTERVENTIONS
Assess skin color every 2 hours
Monitor direct and indirect
bilirubin
Change positions every 2 hours
Massage prominent area
Keep your skin clean and moisture.

64. 4 . Impaired parenting r / t separation
INTERVENTIONS
Bring the baby to the mother for
breastfeeding
Encourage parents to talk to their
children
Involve parents in care when possible
Encourage parents to express feelings.

65. 5 . Risk for injury r / t effects of
phototherapy
INTERVENTIONS
Place the neonate at a distance of 45 cm
from the light source
Let the baby naked except for the eyes
Genital area and buttocks covered with
a fabric that reflects light
Assess the presence of conjunctivitis
every 8 hours

66. 6 . Anxiety : parents r / t therapy given
to Infants .
INTERVENTIONS
Assess the client's knowledge of family
Explain the process of therapy and
treatment
Give health education on how to care
of the baby at home.

67.  Administration of anti-D immunoglobulin to
the Rh-negative mother having Rh-positive
baby to prevent Rh-isoimmunization.
 Minimizing fetomaternal bleeding during
pregnancy
 Prevention of perinatal distress – like
hypoxia, hypothermia, hypoglycemia
PREVENTION

68.  Adequate and early feed to prevent
dehydration and hypoglycemia to reduce
enterohepatic recirculation
 Avoidance of jaundice aggravating drugs like
vitamin K in large doses
 Aspiration of cephalohematoma, if presents
with jaundice
 Management of Rh-sensitized mother during
antenatal period with rising titer of indirect
Coomb’s test

69. COMPLICATIONS
COMPLICATIONS OF PHOTOTHERAPY
The immediately problems
 Dehydration
 Hypothermia
 Loose stool or green stool
 Electric shock
 Skin rash
 Hypocalcemia

70. Long term problems
like sexual
maturation ,retinal
damage and rarely
skin cancer
• Bronze baby
syndrome :It is dark
brown pigmentation
of the skin ,mucous
membrane and urine
following
phototherapy

71. COMPLICATIONS OF EXCHANGE BLOOD
TRANSFUSION
Immediate complications
 Cardiac failure
 Tetany
 Sepsis
 Hyperkalemia
 Umbilical or portal vein perforation
 Hypoglycemia,
 Thrombocytopenia etc .
 DELAYED COMPLICATIONS INCLUDE: extrahepatic
hypertension, portal vein thrombosis ,HIV etc.